<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content ">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<div class="form-group">	
								<label class="col-sm-2 control-label">客户号：</label>
								<div class="col-sm-4">
									<input id="custId" name="custId" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">缴费日期：</label>
								<div class="col-sm-4">
									<input id="payDate" name="payDate" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">失效日期：</label>
								<div class="col-sm-4">
									<input id="expireDate" name="expireDate" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">缴费金额：</label>
								<div class="col-sm-4">
									<input id="payAmt" name="payAmt" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">办公整机维护：</label>
								<div class="col-sm-4">
									<input id="servZjwhFee" name="servZjwhFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">税控器具报税：</label>
								<div class="col-sm-4">
									<input id="servRkqjbrFee" name="servRkqjbrFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">电子申报：</label>
								<div class="col-sm-4">
									<input id="servDzsbFee" name="servDzsbFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">纸质申报：</label>
								<div class="col-sm-4">
									<input id="servZzsbFee" name="servZzsbFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">代领发票：</label>
								<div class="col-sm-4">
									<input id="servDlfpFee" name="servDlfpFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">代打印发票：</label>
								<div class="col-sm-4">
									<input id="servDdyfpFee" name="servDdyfpFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">代理记账、理账：</label>
								<div class="col-sm-4">
									<input id="servLsjzFee" name="servLsjzFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">合计：</label>
								<div class="col-sm-4">
									<input id="annualFee" name="annualFee" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">会员状态,1有效，0无效：</label>
								<div class="col-sm-4">
									<input id="activeStatus" name="activeStatus" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">创建人：</label>
								<div class="col-sm-4">
									<input id="createBy" name="createBy" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">：</label>
								<div class="col-sm-4">
									<input id="createDate" name="createDate" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">数据状态：</label>
								<div class="col-sm-4">
									<input id="state" name="state" class="form-control" type="text">
								</div>
							</div>
														<div class="form-group">	
								<label class="col-sm-2 control-label">备注：</label>
								<div class="col-sm-4">
									<input id="remark" name="remark" class="form-control" type="text">
								</div>
							</div>
																					<div class="form-group">
								<div class="col-sm-4 col-sm-offset-3">
									<button type="submit" class="btn btn-primary">提交</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
	</div>
	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/system/bizCustomerPay/add.js">
	</script>
</body>
</html>
